Procedure for removing blood and tissue from the uterus by means of a suction device.

American feminist activists Carol Downer and Lorraine Rothman developed menstrual extraction in 1971 as a method of removing a woman's menses to avoid an inconvenient period or, more importantly, to end a pregnancy at an early stage. They introduced their work to fellow activists in Los Angeles in the same year the Roe v. Wade case was in court, before the legality of abortion had been established. The two activists wanted to create a safe, simple, affordable means of ending a pregnancy at a time when U.S. law and culture severely limited women's legal and medical options concerning reproductive health.

Rothman fabricated a device called the Del-Em, constructed of easily obtainable laboratory supplies: a jar, rubber stopper, plastic tubing, a cannula, a one-way valve, and a syringe. Downer and Rothman organized self-help clinics for women and demonstrated the uses of the Del-Em. These self-help groups were formed not simply as an introduction to menstrual extraction, but as a broader forum within which women could educate themselves and each other about their bodies and reproductive health in an informal, nonmedical setting. Self-examination with a speculum was one technique employed at the meetings to demystify the female reproductive anatomy. It was within this context of underground, politically oriented sexual health education that Rothman and Downer developed and disseminated the technique of menstrual extraction.

To demonstrate menstrual extraction at self-help meetings, a woman about to begin her period (or who suspected she was pregnant) would volunteer to undergo the procedure, while the other women would watch. The procedure involves the insertion of a flexible 4mm cannula into the os, or cervical opening. The cannula is attached to a long piece of plastic tubing connected to one of two small openings in a rubber stopper covering a jar. A second piece of plastic tubing is connected to the other hole in the stopper; a one-way valve is attached to this piece to control the flow of the contents and attached to a syringe. Once the kit has been assembled and the cannula inserted into the cervix, the woman undergoing the extraction pumps the syringe to gently suction the contents of her uterus, which are caught in the jar. Because she is holding the syringe, she can control the speed and pressure of the extraction, moving at a pace she finds comfortable. The extraction process could be finished in about five minutes.

As an abortion procedure, menstrual extraction offered certain advantages over procedures already in use. With menstrual extraction, cervical dilation is unnecessary and local anesthesia is optional. Cramps are a common side effect, so a mild painkiller might be needed after the procedure is completed. As conceived by Downer and Rothman, it would also be a low-cost procedure, not simply because the tools needed are inexpensive, but also because it doesn't require the skills of a medical doctor to be performed safely.

Menstrual extraction is not a do-it-yourself abortion method. It was intended to be performed by trained women (albeit not performing in a legitimate professional capacity given the illegal status of abortion at the time) who could ensure that the equipment to be used has been properly sterilized and that the woman undergoing the procedure was not in need of medical attention. Menstrual extraction is only suitable as an abortion procedure for women who are four to six weeks pregnant. If attempted later in term, its effectiveness declines significantly and could lead to serious complications.

Menstrual extraction isn't commonly performed in clinics today. Mifepristone is more often used for very early pregnancies these days. Some clinics provide a method similar to menstrual extraction called manual vacuum aspiration for women three to four weeks pregnant. Clinics offer vacuum aspiration abortion for women six to thirteen weeks pregnant, with a larger cannula (requiring cervical dilation) and local anesthesia, and it's often performed with an electric vacuum device. Undoubtedly, underground groups still exist similar to those organized by Downer and Rothman in the 1970s with knowledgeable members willing to perform menstrual extraction. However, one would need to seek them out by word of mouth or through connections in local feminist groups.

For more information see:

Chalker, Rebecca, and Carol Downer. A Woman's Book of Choices: Abortion, Menstrual Extraction, RU-486. Suzann Gage (illus.). Seven Stories Press, 1996.
(Informative book by the women who started it all. Offers a detailed history and instruction on menstrual extraction, as well as illustrations of the Del-Em.)

Numerous articles have been published about menstrual extraction and related techniques like manual vacuum aspiration. Visit PubMed to find abstracts and some full-text articles, or speak with a librarian.

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